This PhD project will work with Care home residents, family Caregivers and Care staff to better understand drinking and low-intake dehydration in Care homes, and to improve fluid intake for residents.
This PhD project will work with people living with dementia in care homes, to support them to drink more, in order to prevent low-intake dehydration. This will be achieved by undertaking a systematic review, which will establish how common low-intake dehydration (from not drinking enough) is among older adults, and then identify groups most at risk of dehydration. Observations and interviews will then be carried out in care homes, to understand what might lead to someone drinking, or not drinking. The themes identified from this will be used to develop a care pathway decision model. The care pathway decision model will then be assessed to see how appropriate and applicable it is for care home settings, in order to improve drinking. Throughout this PhD program, inclusive involvement will be central to the study designs and methodology. By understanding the difficulties faced by people living with dementia in care homes, with regards to their drinks provision, we will be able to better target interventions to improve drinking. If we can increase fluid intake, then we will be able to prevent dehydration and the health conditions and mortality which are associated with it.
Aim and objectives
The project aims: Identify whether people living with dementia in care homes are more vulnerable to low-intake dehydration (as a result of not drinking enough), compared to those not living with dementia, and work with them to identify ways of supporting them to drink more, in order to prevent dehydration.
Systematic Review Objective: Establish how common low-intake dehydration is amongst older adults (≥65 years).
Qualitative Study Objectives: Identify factors that might prevent someone living with dementia, in long term care settings, from drinking. Identify the challenges these decisions might pose for care staff.
Feasibility Study Objective: To develop a care pathway decision model to support care staff, when caring for residents living with dementia who are reluctant or refusing drinks and assess how this works within the setting.
In this first year, I have focussed on the systematic review. I have developed the protocol and inclusion criteria for eligible studies. I have also engaged and trained a team of 7 other reviewers to duplicate each stage of the review process, including title and abstract screening, full text screening and data extraction. The search criteria for the systematic review followed the format: [aged] and [prevalence or incidence] and [dehydration or fluid] and [human] and was searched in 6 databases: Medline-Ovid, Cochrane CENTRAL, Embase (Ovid), CINAHL Complete, Proquest Dissertations & Theses A&I and Nutrition & Food Sciences. 10,059 studies were retrieved from the searches, of which 1611 were duplicates. 8438 titles and abstracts were screened, of which 1339 studies were then full text screened. 81 studies have been assessed in duplicate to be eligible for data extraction, as they include dehydration data measured using either serum/plasma osmolality, serum/plasma osmolarity, saliva osmolality, or accurate and volumetric fluid intake data.
I held a Patient and Public Involvement workshop, with members of the Alzheimer’s Research network in March, in order to advise on the design of the Qualitative study. I also presented to PpiRes (Patient and public involvement in research) and the Alzheimer’s Research network about our plans for the PhD research and sought their views and input, which will be considered and implemented into each study protocol. I visited a care home manager in July and had discussions about how best to carry out research in their setting.
I am currently working on the qualitative study protocol and will then apply it to UEA and NHS ethics.
Anticipated and outputs
The findings of each study of this PhD project will be written up and published in a relevant, peer-reviewed journal. Findings and learnings will also be shared at relevant conferences and meetings. The Alzheimer’s Research Network and PpiRes patient and public involvement forums will also be informed of the findings, as well as other relevant organisations and charities. Findings and learnings from this PhD project will be shared via social media and the local media.
To my knowledge, no one has ever established the prevalence of low-intake dehydration for community-dwelling older adults and provided a comparison to care home residents, using robust measures of low-intake dehydration.
In addition, to my knowledge, researchers have not previously included care home residents with severe dementia or those who lack the capacity to provide consent to research, to understand low-intake dehydration. This PhD project also aims to fill this gap.
Although this research is aimed at older adults living in care homes, it’s anticipated that the learnings will be able to be translated across settings, including the NHS.
Papers and Resources
Parkinson, E., Hooper, L., Poland, F., Roberts, S., Van Hout, E., & Bunn, D. (2021). Prevalence of dehydration among older adults across settings: a systematic review and meta-analysis. In PROSPERO 2021 CRD42021241252.
I am currently developing the qualitative study protocol and will seek the input of PpiRes and the Alzheimer’s Research network for the associated study documents, to ensure that they are user friendly and fit for purpose. I will then apply to NHS and UEA ethics for ethical approval. I will then carry out some relationship-building visits with the care home, prior to formal fieldwork being undertaken.
I will carry out ethnographic observations in the care home(s), and also ethnographic interviews with care home residents, to explore factors that lead, and don’t lead to drinking. I will then carry out semi-structured interviews with family caregivers and care home staff to explore and understanding drinking, and the consequent challenges of poor drinking, further. I will also observe a publicly available discussion forum called “Dementia Talking Point”, hosted by Alzheimer’s UK, to analyse anonymised data about hydration care, and/or issues of dehydration in care homes.
In the meantime, I will continue the data extraction of the systematic review and begin analyses.
Systematic Review Data Extraction and Developing Qualitative Study Protocol.
Researchers and Institutions
Ellice Parkinson (PhD Student)
Diane Bunn (Primary Supervisor)
Lee Hooper (Secondary supervisor)
Fiona Poland (Secondary supervisor), UEA.
Ellice Parkinson, UEA